Lessons Learned: Luis Jácome

Luis Jácome was appointed president of the board of Ecuador’s central bank in 1998 by newly elected President Jamil Mahuad. He and other members of the board resigned in 1999 in protest against a number of crisis-intervention measures they saw as threatening the bank’s independence to set monetary policy. Since the 1970s, Ecuador’s economy had experienced a period of growth fueled by oil exports, but by the mid-1990s the economy was reeling from a series of shocks, among them: a sharp drop in the price of oil, the effects of severe flooding on the country’s agricultural production, and the cost of waging a war with neighboring Peru. The shocks destabilized the country’s banking system, leading to bank runs and spiraling depreciation of the currency. Mahuad was deposed by a military coup in January 1999 and replaced by his vice president, Gustabo Noboa. Shortly after the coup, Ecuador replaced the Ecuadorian sucre with the US dollar, which helped to halt bank runs and restored some trust in the financial system

Lessons Learned: Ignazio Angeloni

Ignazio Angeloni was an adviser on financial integration, financial stability, and monetary policy to the Executive Board of the European Central Bank during the European Sovereign Debt Crisis and later became director general of financial stability. He coordinated the preparations for establishing the Single Supervisory Mechanism (SSM), a component of the European banking union. The SSM was created to address macroprudential gaps identified during the Global Financial Crisis and the Sovereign Debt Crisis. Angeloni has advocated in his academic papers for completing the work of the SSM by establishing a regional deposit insurance scheme that would backstop the work of the related Single Resolution Board of the European banking union, as the Federal Deposit Insurance Corporation does in the United States

Improving The Reporting And Tracking Of Hospital-Acquired Pressure Injuries

Hospital-acquired pressure injuries (HAPIs) affect millions of patients a year, impacting patient safety and creating a significant financial burden for healthcare systems. Inadequate reporting and tracking of HAPIs lead to delays in care, inaccurate data reporting and missed opportunities for quality improvement. This is in large part due to a lack of training and education around HAPIs, poor communication of injuries during hand-off and a lack of system integration. A process improvement program to improve the reporting and tracking accuracy of HAPIs was piloted on two post-surgical units in a large urban cancer center. This initiative combined comprehensive training via a web-based module, and the implementation of an electronic pressure injury risk report that was incorporated into morning huddles and in the hand-off process. Pre and posttests completed by participants revealed a significant increased sense of self-efficacy in identifying, reporting and tracking HAPIs after training (p \u3c.001). The units also sustained a decrease in wound care orders placed on high-risk patients and zero confirmed pressure injuries in the month immediately after implementation. Implementing targeted training and leveraging enhanced reporting via the electronic health record can improve compliance with national standards and improve patient safety overall. A collaborative, interdisciplinary approach and reinforcement of processes are essential in process improvement sustainability

One Move, Many Wins: Green Social Housing As A Solution For Housing Insecurity And Residential Energy Inefficiency In New Haven, Ct

This thesis explores the dual challenges of housing insecurity and residential energy inefficiency in New Haven, Connecticut, and advances green social housing as a transformative policy response. Through a qualitative research design that integrates semi-structured interviews, document analysis, and policy review, the study uncovers the structural conditions that drive unaffordable, unhealthy, and energy-inefficient housing for low- and moderate-income residents. The findings reveal that high utility costs, poor building infrastructure, and disempowering tenant–landlord dynamics are not isolated issues but manifestations of deeper systemic inequities in housing and energy governance. Green social housing emerges as a strategic intervention that aligns sustainable building practices with affordability, equity, and public health outcomes. By centering community control, ecological design, and long-term investment in underserved neighborhoods, this model addresses both the root causes and symptoms of energy and housing precarity. The study calls for an integrated policy framework that includes stronger tenant protections, equitable financing mechanisms, institutional accountability, and cross-sector collaboration. New Haven’s case offers critical insights for other cities seeking to advance environmental justice, climate resilience, and social equity through holistic approaches to the built environment. This research contributes to a growing body of scholarship that frames housing policy as a key site of climate action and public health innovation

Bipolar Disorder Among Individuals With Atopic Dermatitis: A Case-Control Study In The All Of Us Research Program

Background: Atopic dermatitis has been associated with psychiatric comorbidities.Objectives: To characterize the association between atopic dermatitis and bipolar disorder with a case-control study of the NIH All of Us Research Program. Methods: Utilizing Systemized Nomenclature of Medicine diagnostic codes, we identified cases of atopic dermatitis. Four age, sex, and race/ethnicity matched controls were found for each case using propensity score matching. After controlling for age, sex, race/ethnicity, income, smoking status, and depression, the relationship between atopic dermatitis and bipolar disorder was evaluated using logistic regression. Results: We identified 13,431 atopic dermatitis cases with 53,724 matched controls. Participants with atopic dermatitis were more likely than controls to have bipolar disorder (7.8% vs. 4.6%, P\u3c.001). After adjusting for demographics and comorbidities, we observed a significant association between atopic dermatitis and bipolar disorder (odds ratio 1.49, 95% confidence interval 1.37-1.62, P\u3c.001). Conclusion: Compared to individuals without atopic dermatitis, individuals with atopic dermatitis have 1.49-fold increased odds of having bipolar disorder. Further investigation is needed to further understand this association

Exploring the Limits of Multimodal Foundation Models for Visual Temporal Reasoning and Gesture Recognition Tasks

Multimodal foundation models (MFMs) have demonstrated impressive capabilities in static vision-language tasks such as image captioning, video summarization, and cross modal retrieval. However, their ability to reason over time—especially in gesture-rich video inputs—remains limited. This thesis investigates the temporal reasoning capabilities of MFMs in the context of gesture understanding, a critical component for enabling more expressive human-robot interaction. Through a preliminary study, we show that prompting-based strategies offer only marginal improvements in temporal reasoning, despite producing accurate frame-by-frame descriptions. To more rigorously evaluate these limitations, we introduce TOMATO, a benchmark designed to assess visual temporal reasoning through three diagnostic principles: Multi-Frame Gain, Frame Order Sensitivity, and Frame Information Disparity. Our analysis reveals that existing benchmarks often overestimate model performance by allowing shortcuts that do not require true temporal integration. Building on these insights, we examine the role of both the vision encoder and language backbone in gesture interpretation, finding that the latter presents a major bottleneck in temporal abstraction. This motivates future work on improving model architectures and reasoning strategies, with the goal of enabling MFMs to move beyond gesture classification toward more general and intent-aware gesture understanding for real-world human-robot interaction

Cost-Effectiveness Of New Monoclonal Antibody And Maternal Immunization For The Prevention Of Respiratory Syncytial Virus (rsv) Disease In Infants: A Systematic Review

AbstractIntroduction: Respiratory syncytial virus (RSV) remains a major cause of morbidity and mortality among infants and young children worldwide. Given the lack of specific therapeutic treatments for RSV that are suitable for universal use, the development of effective prevention strategies is of paramount importance. Previously, palivizumab was utilized for long-term prophylaxis of RSV infections; however, it was only recommended for specific populations due to its high cost and limited overall effectiveness. In 2023, the U.S. FDA approved RSVpreF maternal vaccine (Abrysvo™, Pfizer), and nirsevimab (Beyfortus™, Sanofi and AstraZeneca) for the prevention of RSV to newborns. Two newly developed interventions have demonstrated potential in reducing RSV burden in children aged 0-5 years and replaced existing interventions. However, their cost-effectiveness has not been systematically reviewed. This study aims to assess the cost-effectiveness of nirsevimab and RSVpreF in infants through a systematic review and provide some insights for policy making. Methods: Relevant studies were searched, screened and identified from PubMed, Scopus and Medline from 2020 to 2025. Studies were eligible if they met the multiple inclusion criteria based on Population, Intervention, Comparison, and Outcome (PICO) framework. The quality of included studies was assessed based on Consolidated Health Economic Evaluation Reporting Standards (CHEERS) 2022 statements. Risk of bias was assessed followed the advice from National Institute for Health and Clinical Excellence (NICE) in UK. For data analysis, extracted information from included studies and standardized all results to 2025 USD. Pooled incremental cost-effective ratios (ICERs )from high-income countries (HICs) and low- and middle-income countries (LMICs) and from different perspectives were estimated. Results: I identified 592 studies, of which 21 studies were included in the systematic review. Most studies indicated that nirsevimab and RSVpreF were cost-effective compared to no intervention and to the existing palivizumab (n=20). The pooled ICER for nirsevimab cost $20,326 ($541-$165,742) per quality-adjusted life-years (QALY) gained, and for RSVpreF was$58,589/QALY gained ($1,686-$427,836), compared with no interventions. In HICs, nirsevimab would cost $20,910/QALY ($3,562-$165,742), and the ICER for RSVpreF was$35,046/QALY ($13,028-$427,836). In LMICs, pooled ICER was $4,766/QALY ($541-$21,023) gained for nirsevimab and$7,756/QALY ($1,686-$25,564) gained. The sensitivity analysis highlighted that intervention cost and real-world effectiveness were critical factors influencing cost-effectiveness outcomes. Conclusion: Both nirsevimab and RSVpreF are cost-effective in preventing RSV in infants. From the results of the subgroup analysis, nirsevimab may be more cost-effective than RSVpreF. And due to contexts of different product prices and disease burden, RSVpreventions are more cost-effective in LMICs compared to HICs. These findings support the inclusion of RSV prophylaxis in immunization programs, with careful consideration of country-specific healthcare policies and economic conditions. Further studies are needed to assess potential biases from industry sponsorship and explore additional economic measures such as net monetary benefit (NMB) to strengthen cost-effectiveness evaluations

Analysis Of Post-Operative Recovery From Microsurgical Breast Reconstruction As Modified By Anterior Quadratus Lumborum Regional Blockade

Breast cancer patients who undergo mastectomy for treatment have the option to proceed with cosmetic breast reconstruction, of which microsurgical flap techniques have become more and more predominant. Optimized recovery from these large-scale surgeries can impact both hospital resources and long-term patient health. The abdominal donor site is the prime suspect for the postoperative pain and delay in return of baseline functional status. Previous literature and clinical practice support the surgically placed transverses abdominal regional block as part of the multimodal analgesia regimen to aid recovery due to incisional pain control, but the technique lacks the ability to impact visceral pain. The anterior quadratus lumborum block, an emerging advanced fascial plane block is a promising alternative, because of its ability to block stimuli in the anterior abdominal region from both somatic and visceral stimuli. This study follows a quality improvement initiative completed as part of a larger movement to implement new Early Recovery After Surgery (ERAS)-informed guidelines to improve recovery of patients who undergo the Deep Inferior Epigastric Artery Perforator (DIEP) microsurgical breast reconstruction procedure. 413 patients in total were retrospectively analyzed in this study. The control group (N=254) underwent the procedure before implementation of the pilot and received the standard clinical practice of an intraoperative surgically placed, landmark-based intraoperative transversus abdominus plane block using bupivacaine and liposomal bupivacaine. The experimental group (N=159) underwent the procedure after implementation of this new clinical pathway and received preoperative ultra-sound guided bilateral anterior quadratus lumborum block (aQLB) by a regional anesthesia team using bupivacaine plus dexamethasone sodium phosphate (DXP) and methylprednisolone acetate (MPA). Our working hypothesis was implementation of preoperative anesthesiologist-placed aQLB would improve postoperative outcomes after DIEP breast reconstruction. The primary outcome measured was average daily opioid consumption, and secondary outcomes included average daily pain scores, time to first ambulation, and hospital length of stay. Final analysis of the data revealed a statistically significant decrease in the time to first ambulation in the experimental group by 17% or 7.7 hours (p = \u3c0.005). Other secondary outcome metrics such as average daily opioid usage and hospital length of stay trended towards improvement in the experimental group, but did not reach statistical significance. Average daily pain was statistically significantly higher for the experimental group, but as stated above, did not result in increased opioid consumption for the experimental group. Subgroup analysis showed that the patients who received a quadratus lumborum block alongside a regional chest block were the ones who saw the greatest improvement in time to first ambulation, compared to those who only received a quadratus lumborum block. The data demonstrates that the anterior quadratus lumborum block may have utility in improving the return to functional status in the immediate postoperative period following DIEP breast reconstruction. We also see that chest regional blockade may have a synergistic effect alongside the quadratus lumborum block in amplifying the improvements seen in mobility. The quadratus lumborum block was also shown to be non-inferior in terms of opioid consumption or hospital length of stay compared to the status quo surgically placed landmark-based transversus abdominus block with liposomal bupivacaine

Assessing The Costs Of Illness Attributable To Leptospirosis

Leptospirosis, caused by the spirochetes of the genus Leptospira, is a zoonotic bacterialdisease endemic to tropical regions and lower middle income countries (LMICs). Leptospirosis causes an estimated 1 million cases and more than 58,900 deaths annually.(Costa et al., 2015; Torgeson et al., 2015) In addition to human health, leptospirosis significantly impacts animal health and the livestock industry, particularly through reproductive losses, increased treatment costs, and decreased milk production, which exacerbates global insecurity.(Bennet, 2015; Torgeson et al., 2015) The estimated global cost loss to productivity due to disease is estimated at Int$ 29.3 billion. (Agampodi et al., 2023) Because of its non-specific clinical manifestations coupled with the lack of timely and actionable diagnostics, leptospirosis lacks comprehensive global burden estimates, contributing to its status as a neglected disease, despite its significant implications for human and animal health.(Costa et al., 2015) In this paper we argue that burden of disease metrics are the highest priority for the leptospirosis field to demonstrate to policy makers and funders the high toll leptospirosis takes and to advocate for its recognition as a significant public health challenge. This paper aims to address a known gap in the global burden of disease research for leptospirosis by highlighting the economic impacts of this disease on human and animal health at the regional and country levels. We carried out a systematic literature review that screened four databases and articles published between 1970 and 2025, without restrictions to language. 34 articles were ultimately included in the review. This work highlights several limitations, including a lack of accessible diagnostic assays and regional discrepancies in data collection. Given that the actual costs of illness could be much higher as many cases go unidentified, it is important to raise awareness among stakeholders to develop actionable control methods and motivate its inclusion in the global health agenda